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Erratum to: Short Term Economic Evaluation of the Digital Platform “Support, Monitoring and Reminder Technology for Mild Dementia” (SMART4MD) for People with Mild Cognitive Impairment and Their Informal Caregivers
Blekinge Institute of Technology, Faculty of Engineering, Department of Health.ORCID iD: 0000-0001-9360-2809
Lunds universitet.
Lunds universitet.
Blekinge Institute of Technology, Faculty of Engineering, Department of Industrial Economics.ORCID iD: 0000-0002-0302-6244
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2024 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 99, no 2, p. 799-810Article in journal (Other academic) Published
Abstract [en]

This contribution corrects cost data from our previously published version in which the 6-month cost data was not censored at baseline and 6-month survey dates. Consequently, the average costs for persons with mild cognitive impairment (PwMCI) and their informal caregivers include costs that occurred outside the initial 6-month period for both intervention and control groups. In this erratum, we have repeated the analysis after appropriately censoring the costs. The results led to numerical differences. However, as both the intervention and control groups have been treated exactly the same, the differences between groups remain insignificant and the general interpretation of the results stand as presented in the original publication. The interpretation of the results in terms of cost-effectiveness has changed for informal caregivers, shifting from "dominant" to "not cost-effective", and for dyads, shifting from "less costly and less effective" to "more costly and less effective". Consequently, ICER and CEAC curves have also changed (see Corrected Fig. 1). However, these changes did not affect the conclusion of the article. 

Place, publisher, year, edition, pages
2024. Vol. 99, no 2, p. 799-810
Keywords [en]
aged, Alzheimer disease, caregiver, clinical article, controlled study, cost effectiveness analysis, dementia, disease management, drug therapy, economic evaluation, informal caregiver, memory, mild cognitive impairment, mobile application, smartphone, telehealth, therapy, erratum
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Applied Health Technology
Identifiers
URN: urn:nbn:se:bth-26986DOI: 10.3233/jad-249009PubMedID: 38701171Scopus ID: 2-s2.0-85193646507OAI: oai:DiVA.org:bth-26986DiVA, id: diva2:1904298
Available from: 2024-10-08 Created: 2024-10-08 Last updated: 2024-10-15Bibliographically approved
In thesis
1. Health Technology Assessment of an mHealth application (SMART4MD) designed for persons with mild cognitive impairment (PwMCI) and their informal caregivers: Effectiveness and cost-effectiveness analyses
Open this publication in new window or tab >>Health Technology Assessment of an mHealth application (SMART4MD) designed for persons with mild cognitive impairment (PwMCI) and their informal caregivers: Effectiveness and cost-effectiveness analyses
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Health Technology Assessment (HTA) plays a pivotal role in decision-making within the healthcare sectors of developed countries, such as Sweden and Spain. This thesis investigates the efficacy and cost-effectiveness of a mobile health (mHealth) intervention in addition to standard care compared to standard care only. The intervention, a tablet-based application named Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD), was implemented in an 18-month pragmatic randomized controlled trial involving persons with mild cognitive impairment (PwMCI) and their informal caregivers. The trial was conducted in Sweden, Spain, and Belgium from December 2017 to September 2020. Its objective was to enhance or sustain the health-related quality of life (HRQoL) of PwMCI and their informal caregivers. Out of the total 1083 participants, 539 were assigned to the intervention group and 544 to the control group. The Belgium site was excluded from analyses due to its low participant count (n=5) and all participants were lost to follow-up at the 18-month. The aim of this thesis was to evaluate the effectiveness and cost-effectiveness of the mHealth intervention introduced through the SMART4MD trial. 

Four studies were undertaken to achieve this objective. Study I encompassed a systematic literature review, aiming to gather and critically appraise the existing evidence available on cost-effectiveness of mHealth intervention designed for older adults. Study I found limited evidence of mHealth interventions being cost-effective within this demographic. 

The effect outcomes data for the remaining three studies was obtained from the SMART4MD trial, while healthcare utilization data for Studies II and IV was retrieved from healthcare registers of the Blekinge regional council, Sweden and Hospital de Terrassa, Terrassa Sanitary Consortium, Terrassa (Barcelona), Spain. 

The effectiveness of the SMART4MD application in addition to standard care compared to standard care alone was investigated across Sweden and Spain during the 18-month trial period (Study III). For PwMCI, the primary outcome measure was quality of life in Alzheimer’s disease scale (QoL-AD), while secondary outcome measures included quality adjusted life years (QALY) measured by EQ-5D-3L index score, mini-mental state examination (MMSE) score, functional status by the Lawton instrumental activities of daily living (IADL) scale and medication adherence. The outcome measures for informal caregivers were QALY and caregiver burden. The findings were presented in terms of the mean changes in outcome measures between the intervention and control groups. For PwMCI, no statistically significant differences were observed between the intervention and control groups. In contrast, the results indicated a significant improvement in the health-related quality of life (measured by QALY) for informal caregivers and dyads in the intervention group when compared to the control group at 18-month follow-up. Notably, the dropout rate was 41.9% within the intervention group (225/537) and 37.7% within the control group (204/541), with a p-value of 0.160 showing insignificant difference in dropout between the groups. 

The within-trial cost-effectiveness of the mHealth intervention (tablet-based application) was investigated at short-term (6-month) and for the trial duration (18-month) from the perspective of the healthcare provider (Studies II and IV respectively). These analyses were based on the study sample collected from the Swedish site, due to the unavailability of cost data from the Spanish sites, except for PwMCI from CST site. The primary outcome measure was QALY for both PwMCI and informal caregivers, whereas the secondary outcome measures were QoL-AD, and MMSE for PwMCI, and Zarit burden interview short form (ZBI) for informal caregivers. Results were presented in terms of incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). Both short-term and full trial duration results indicated that intervention was dominated by standard care for PwMCI and dyads. Further, intervention was not found cost-effective for informal caregivers in terms of improving HRQoL.

The overall results of this thesis indicate that the app provided in the SMART4MD trial did not significantly improve the quality of life or prove to be cost-effective for PwMCI. However, it did improve the quality of life of informal caregivers, though it was not found to be cost-effective for them either. Further research in this area is needed, particularly through larger sample sizes, longer follow-up, and incentives for sustained app usage. Additionally, further investigations should prioritize strategies to minimize dropout rates within mHealth interventions.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2024. p. 109
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 2024:15
Keywords
Aged, Cost-effectiveness analysis, Economic evaluation, Gerontechnology, Carer, Elderly, Memory, mHealth, Mild cognitive impairment, Mild dementia, Mobile application, Smartphone
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Applied Health Technology
Identifiers
urn:nbn:se:bth-26984 (URN)978-91-7295-488-5 (ISBN)
Public defence
2024-11-20, J1630, Blekinge institute of technology, Karlskrona, 13:00 (English)
Opponent
Supervisors
Funder
EU, Horizon 2020, 643399
Available from: 2024-10-14 Created: 2024-10-08 Last updated: 2025-01-15Bibliographically approved

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Ghani, ZartashiaAndersson, MartinSanmartin Berglund, JohanAnderberg, Peter

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